Coccidioidomycosis (Valley Fever; San Joaquin Fever)

A disease caused by the fungus Coccidioides immitis, usually occurring in a primary form as an acute benign asymptomatic or self-limited respiratory infection, occasionally disseminating to cause focal lesions in skin, subcutaneous tissues, lymph nodes, bones, liver, kidneys, meninges, brain, or other tissues.

Primary coccidioidomycosis is usually asymptomatic, but nonspecific respiratory symptoms resembling influenza or acute bronchitis sometimes occur or, less often, acute pneumonia or pleural effusion. Symptoms, in decreasing order of frequency, include fever, cough, chest pain, chills, sputum production, sore throat, and hemoptysis.

Progressive disseminated coccidioidomycosis may develop a few weeks, months, or occasionally years after primary infections,, is more common in men than women and is more likely to occur in association with HIV infection, immunosuppressive therapy

Symptoms often are nonspecific, including low-grade fever, anorexia, weight loss, and weakness. Extensive pulmonary involvement may cause progressive cyanosis, dyspnea, and discharge of mucopurulent or bloody sputum. Extrapulmonary lesions are usually focal, involving one or more tissue sites in bones, joints, skin, subcutaneous tissues, viscera, brain, or meninges. Draining sinus tracts sometimes connect deeper lesions to the skin. Localized extrapulmonary lesions often become chronic and recur frequently, sometimes long after completion of seemingly successful antifungal therapy.

Pemphigoid
1. Ulcerative lesions on the skin and oral mucosa.
2. An autoimmune disease in which patients have autoantibodies against basal cells (desmosome attachment to the basement membrane).
3. Histologically, the entire epithelium appears to separate from the connective tissue. There is no acantholysis.
4. A positive Nikolsky sign is observed.
5. Complications include blindness, due to ocular lesions present in some patients.
6. Treatment: corticosteroids.

Hereditary spherocytosis.

Functionally normal cells which are destroyed .in spleen because of the structural abnormality. It is transmitted as an autosomal dominant trait 

Congenital hemolytic anemia due to genetically determined abnormal spectrin and ankyrin molecules, leading to defects in red blood cell membrane, causing spherical shape and lack of plasticity
Red blood cells become trapped within spleen and have less than usual 120 day lifespan
Splenic function is normal
Osmotic fragility: increased; basis for diagnostic testing 

Description

Firm, deep red tissue, thin capsule, no grossly identifiable malpighian follicles, 100-1000g
Peripheral blood images
Marked congestion in cords
Sinuses appear empty but actually contain ghost red blood cells
May have prominent endothelial lined sinuses, hemosiderin deposition, erythrophagocytosis

Urinary tract infection
Most often caused by gram-negative, rod-shaped bacteria that are normal residents of the enteric tract, especially Escherichia coli.

Clinical manifestations: 

frequent urination, dysuria, pyuria (increased PMNs), hematuria, and bacteriuria.

May lead to infection of the urinary bladder (cystitis) or kidney (pyelonephritis).

Varicose Veins  
- are abnormally dilated, tortuous veins produced by prolonged increase in intraluminal pressure and loss of vessel wall support. 

- The superficial veins of the leg are typically involved  

-venous pressures in these sites can be markedly elevated -> venous stasis and pedal edema (simple orthostatic edema)

-Some 10% to 20% of adult males and 25% to 33% of adult females develop lower extremity varicose  veins  

RISK FACTORS 
-> obesity  
-> Female gender  
-> pregnancy.  
-> familial tendency (premature varicosities results from imperfect venous wall development) 

 Morphology
 
- wall thinning  
- intimal fibrosis in adjacent segments 
- spotty medial calcifications (phlebosclerosis) 
- Focal intraluminal thrombosis 
- venous valve deformities (rolling and shortening) 

COMPLICATIONS
 
- stasis, congestion, edema, pain, and thrombosis 
- chronic varicose ulcers 
- embolism is very rare. 

Hepatitis D virus—can only infect cells previously infected with hepatitis B. 
 Delta hepatitis (HDV) is associated with a 35-nm RNA virus composed of a delta antigen-bearing core surrounded by HBV's Ag coat;

HDV requires HBV for replication.

Delta hepatitis can cause quiescent HBV states to suddenly worsened . Its transmission is the same as that of HBV.
 
 Hepatitis E virus—a high mortality rate in infected pregnant women.

Hepatitis E (HEV) is caused by a single-stranded RNA virus. The disease is typically self-limited and does not evolve into chronic hepatitis; it may, however, be cholestatic.

Pregnant women may develop fulminant disease.

Transmission is by the fecal oral route.

HEV occurs mainly in India, Nepal, Pakistan, and Southeast Asia.